thyroid disorder why your doctor won't find yours...
TRANSCRIPT
2
Introduction
I have never let my schooling interfere with my education.
Mark Twain
This is the fourth e book I have written and posted. The story may be familiar to
those of you who have read the others. Still, it is a compelling story, and was the
direct impetus for my taking my health into my own hands.
Early in my medical career at a routine GYN visit, I was told that I had a mass in
my right ovary and needed surgery.
What?! I thought, and undoubtedly said. Laparoscopic surgery was not offered
as an option. At the time, I lived alone, ran my own medical practice, and was my
sole financial support. There was no way I could, or would, put myself in dry dock
for gynecologic surgery. I was very familiar with hospitals and their routines. I did
not have any romantic notions about what the experience was going to be. I
would be a huge chunk of meat on a slab, one of many that got 'processed'
through the OR every day.
I run high anxiety on an average day. This event would trigger absurd levels. I
would be spring-loaded. It would be difficult for the hospital staff to understand
3
me, and for me to identify with their perspectives. It would be an interpersonal
disaster.
I was having no symptoms whatever from this mass. Couldn't we slow this down
a bit and get some idea of a diagnosis without a major, life-disrupting event?
Apparently we could not, in the opinion of the professional with whom I spoke.
The usual pressure was being applied. The C word was being liberally invoked. I
would have had to be a lot more scared of cancer than I was of surgery or of
going into a huge financial hole to have that influence me. I would have had to
know nothing about pathology or any of the other things that I had studied in
medical school.
There were many things that right lower quadrant masses could be. The surgeon
really could not relate to the idea that I would sooner have catapulted myself into
lunar orbit than experience major surgery. So we had a friendly, collegial parting
of the ways.
I figured that if I had cancer, I should be sick. I never did believe the 'silent killer'
propaganda. I had interviewed lots of patients with cancer. They were sick. They
had been having symptoms for years. Either they, or their doctor, or both, had
been ignoring them.
4
There were three terribly lonely years after that while I watched what evolved and
thought about what to do. I spoke to no one, because I knew if I said one word to
anybody--parents, friends, colleagues -- the pressure would be on again. I was
concerned, but I am also strong-willed. My medical degree had to mean
something.
I researched the possibilities for right lower quadrant masses. I read about the
common tumors, and the more grisly rare ones. It could be anything, but it
probably wasn't. It was probably some ordinary, garden variety mass.
I researched the percentage chances for each of these. I had some background
in the human body, and I certainly had final say over what was going to happen
to me. I stayed silent until I knew that if the mass had been cancer, I would have
been dead already. That was it. From the information I had gathered and the
symptom complex as it evolved, the diagnosis was made. It was endometriosis.
So now I had a diagnosis, but I still had endometriosis. The mass was getting
larger and more tender, no question about that. I had been taking the vitamins
and herbs that were supposed to help. They had no impact. I was starting to
accept that I might have to calm down and choose surgery, when my mother
came to visit. She handed me a book called The Immune Power Diet by Thomas
Berger, MD. She often gave me books that she was curious about but did not
have the time to read. I devoured them. Berger claimed that there are seven
5
foods that frequently provoke symptoms. These foods are wheat, corn, soy,
sugar, dairy, eggs, and Baker’s and brewer’s yeasts. He called them the 'sinister
seven', and he listed the symptoms and disease states that these foods could
cause in a sensitive individual.
The list was long and included may organ systems. I was stunned. I had heard
nothing about this in medical school or from mainstream therapeutics. The list
included pre-menstrual syndrome, but not endometriosis. Never at a loss for
clinical innovation, I reasoned that if these foods could cause all these other
symptoms, perhaps they could cause endometriosis. I stopped eating them
immediately. Within twenty four hours, the right lower quadrant pain that had
been backing me into a corner was gone. GONE! - the sword of Damocles that
had hung over my head for three years!
And then I got it:
They really don't know all there is to know about healing the body in mainstream medical circles….
What else don't they know?
Now I was on fire. I researched the Internet and took every course I heard about.
I took courses in Functional Medicine, Orthomolecular Medicine and Psychiatry,
6
Naturopathy, Chiropractics, Nutrition, Homeopathy, and Herbal and Energy
Medicine. If it seemed at all rational to me, I studied it.
I met a lot of like-minded people along the way and learned that many people
were discontent with mainstream therapeutics. I learned about the objective
problems and conflicts of interest with which the industrial medical complex is
riddled. I learned that mainstream medicine and all of its major journals are
owned by the pharmaceutical industry, through its powerful lobbying, grants for
research, funding chairs at universities, and the phenomenal amount of money it
can afford to spend on advertizing. Pharmaceutical firms charge extremely
inflated prices for their products, no matter what they say about how much it
costs to bring a new drug to market.
I have seen thoughtful people go through agony because they differed with their
mainstream clinician. With or without medical background, I have seen parents
make the wrong choice, vaccinate for example, and have their child descend into
autism. I have stood by while friends and neighbors followed mainstream advice
and developed autoimmune and inflammatory disorders. Once a patient has
come to clarity about taking a position that differs from the mainstream
recommendation, any interaction with a mainstream clinician can result in
contention and assault.
7
So what happens now?
Thyroid Disorder: Why Your Doctor Won't Find Yours Even Though You
Have All the Symptoms addresses fundamental issues that are important for
the diagnosis and the resolution of your thyroid symptoms. It covers how your
thyroid gland functions, how thyroid hormone impacts your cells, and why
common thyroid symptoms such as low energy, falling hair and inability to lose
weight can worsen at menopause.
This is an e-book for any person who wants to take greater responsibility for his
or her own health.
Since no book can possibly answer all of the questions that you may have, I do a
number of educational presentations that address them. We will send you
information about these as they come up.
Thyroid disorder -- What is the story?
Thyroid disease is the most common problem affecting your body's hormone
secreting glands. An estimate based on statistics gathered by the American
Association of Clinical Endocrinologists indicates that approximately 27 million
Americans — as much as seven to eight percent of the population — have some
8
form of thyroid disorder. And, according to this estimate, roughly half of these
suffering people remain undiagnosed.
Eighty percent of thyroid problems result in an underactive thyroid gland, or
hypothyroidism. The other twenty percent produce over activity, hyperthyroidism.
Women constitute about 80% of Americans with thyroid disease. Women are also
five times more likely than men to develop an underactive thyroid.
Thyroid autoimmune disease is a condition in which the body makes antibodies
that attack the thyroid gland and its function. This is the most common
autoimmune disease in the US. Only one-third of those with thyroid autoimmune
disease are ever diagnosed. Runaway environmental pollutants and the
thousands of new chemicals in our environment are the most likely cause of
autoimmune thyroid problems. Some of these chemicals are hormone mimics.
Others are hormone blockers. Others are immune disrupters. Many are low level
poisons. The common result is that your body wrongly attacks your thyroid gland,
which becomes inflamed, producing non-optimal amounts, of active hormone.
Why is thyroid hormone so important?
The function of your thyroid is central to your overall well-being. Every cell in your
body, including the cells in your brain, needs miniscule amounts of thyroid
hormone to function properly. Thyroid hormone regulates cell temperature,
energy production, cell function, cell growth and your body's metabolic rate.
9
When your thyroid hormone is low or not functioning optimally, you may
experience decreased energy, unstable or unpleasant mood, decreased
resistance to infection, increased inflammation, altered fat metabolism or one of
the many other problems listed for you below.
Diminished active thyroid hormone levels in the elderly are associated with
lowered attention, depression, increased mortality, and lowered ability to perform
the activities of daily living. Low thyroid makes any illness worse.
Why there are so many problems diagnosing thyroid disease…
Twenty-six thousand people at a Colorado State Fair volunteered to have their
thyroid function tested. They submitted to routine blood testing and filled out a
short questionnaire. The blood tests used were not highly sophisticated tests;
they were just traditional testing for thyroid problems.
The subsequent study was published in 2000. The Colorado Thyroid Disease
Prevalence Study disclosed that 10% of the study participants had abnormal
thyroid function that had not been discovered by that person's doctor. So,
thirteen million people nationally may have undetected thyroid disorder, most of
them being women.
10
The model that doctors are still using to describe to patients how the thyroid
gland works is hopelessly old and simplistic. Doctors use this traditional model
because it is true, in part. But it is only a very small part of the big picture of how
thyroid hormone is made, regulated and functions in your body.
Thyroid stimulating hormone (TSH) is produced in a part of your brain called the
anterior pituitary. TSH from the anterior pituitary then stimulates your thyroid
gland to produce thyroid hormone. When a sufficient amount of hormone is
produced, a feedback loop tells your brain to slow down the production of TSH.
When TSH production is diminished, the stimulation of your thyroid gland to
produce hormone is lessened. When the amount of thyroid hormone in your
blood drops too low, your brain gets the signal to produce more TSH, and the
production of thyroid hormone goes back up again.
This model is being used to justify the common practice of testing only TSH
level to screen for thyroid disorder. The function of the most central metabolic
gland in your body, the gland that regulates your cell temperature, energy
production, cell function, cell growth and the metabolic rate of your entire body, is
being assessed by one test only. This is the current standard of care. With
increased medical test rationing under the impetus of medical care cost
containment becoming mandatory, there is little hope of getting comprehensive
thyroid testing from the usual health care provider.
11
If you go to your doctor with the most obvious symptoms of low thyroid function
and your TSH measurement comes back normal, he will tell you that your
problems are not due to low thyroid. You then may go on a years-long wild goose
chase trying to find out why your hair is falling out, you are tired all the time, you
can't lose weight, and your skin is sagging.
Cholesterol is one of your body's important fatty acids. Thyroid hormone
balances fatty acid metabolism. So if you are low thyroid and your doctor has not
figured that out, your high cholesterol will be treated with pharmaceuticals
instead of diet, exercise and corrected thyroid hormone levels.
Basing thyroid treatment decisions on TSH measurement alone is totally unsuited
for detecting subtle thyroid failure. The thyroid system in your body is much more
complex than the current model describes. TSH reflects the status of only one
kind of thyroid hormone receptor, the one in the anterior pituitary of your brain.
There are different types of thyroid receptors on different organs in your body, in
different areas of your body, and even in different areas of a particular organ in
your body. Using TSH from the anterior pituitary alone to determine the status of
thyroid hormone function in your entire body is simplistic, to put it mildly. It is
analogous to using the thermostat in one room of a hotel to decide the
temperature for every single room in the building.
12
Thyroid receptor sites come in different varieties even when they are on the
same organ. They differ in the ways in which they bind thyroid hormone and the
ways in which they send the signal that the binding of the hormone initiates.
Certain substances can block the binding of active thyroid hormone to its
receptor site. And what these substances are can be different for different body
sites.
These are among the many factors that impact the way thyroid hormone works in
your body. It is complicated, and it gets even more involved. The thyroid gland
produces T4 that is the storage form of thyroid hormone which is found in your
bloodstream. T4 circulates around in your blood until it is transported into one of
your cells. Inside the cell, T4 is converted into T3. The 'four' and 'three' refer to
the number of iodine molecules that the thyroid hormone contains. T3 is the
active form of the hormone. Iodine is central to both the formation and the
activation of thyroid hormone. Iodine deficiency in patients is rarely diagnosed,
yet it is a common cause of low thyroid and thyroid gland dysfunction.
There are many factors that can inhibit the conversion of T4 into T3. Nutrient
deficiencies, fasting, certain medications, aging, alcohol, cigarette smoking and
stress, will all inhibit this conversion, as will fluoride and non-fermented soy
products. The conversion can be deterred by any agent that displaces iodine
from the thyroid hormone molecule. One example is fluoride, the aluminum
industry waste product alleged to prevent tooth decay. The scientific evidence for
13
its actually preventing tooth decay is scant. (See www.drmercola.com) What
using it in dental materials and municipal water supplies prevents for sure is the
producers of aluminum’s having to spend money to dispose of this toxic
chemical. Instead, it is sold to toothpaste manufacturers, dentists and
municipalities that put it in their water supplies. I am continually stunned at how
literate people, speaking the same language, living in the same country, can view
this issue from such divergent viewpoints. Well, follow the money, as they say.
Other factors can impact either the formation or the function of thyroid hormone.
They include
the effective transport of T4 to into the cell
the capacity of T3 to function actively once it returns to the intercellular
environment, i.e. once it gets back out of the cell into the blood stream
the responsiveness of the thyroid receptor sites on the different organs of
the body to the T3
and, finally, the presence or absence of other hormones and
neurotransmitters that are important for thyroid hormone function. For
example, estrogen is a synergist for thyroid hormone. It makes the
function of thyroid hormone stronger. When estrogen levels drop at
menopause, thyroid hormone potency is negatively impacted. So you get
the symptoms of menopause and low thyroid at the same time.
14
The conversion of T4 into T3 inside the cell is also not so simple. When T4 goes
into a cell, an enzyme called a de-iodinase must remove one iodine molecule to
make it intoT3. Then T3 comes back out of the cell and goes into the blood
stream to its end site, the place in your body where it works.
There are different types of de-iodinases that function in different organs. There
are different de-iodinases for different areas of your body. And the ability of any of
these de-iodinases to function will depend upon the environmental conditions
they encounter at that particular location in your body, such as pH and the ratio of
pro-oxidants to anti-oxidants.
Finally, in 2003, the British Medical Journal acknowledged that, "…A judicious
initiation of [thyroid hormone] treatment should be guided by clinical and
metabolic presentation and thyroid hormone concentrations and not by serum
TSH concentration." (British Medical Journal 2003; 326:311-312).
This medical authority is acknowledging that the treatment of hypothyroidism is
much more complex than giving a standard dose of the standard form of thyroid
hormone if your TSH is high. Proper treatment also involves the correction of
whatever condition has put you into the low thyroid state. Appropriate treatment
may involve careful trials of different forms of thyroid hormone to find the one that
is right for you. Low thyroid is usually easy to correct.
15
If your thyroid disorder is missed, not only do you feel ill, but also you may have
other symptoms that get treated inappropriately. The most egregious of these is
high cholesterol. Fatty acid metabolism depends upon appropriate thyroid
hormone activity. Cholesterol is a fatty acid. High cholesterol can be a symptom
of low thyroid hormone, but if your doctor does not find your thyroid disorder, you
are liable to be given many pharmaceuticals for multiple problems. Some of
these medications interfere with important biochemical processes in your body
and have dangerous side effects, like the drugs for lowering cholesterol that have
proliferated like rabbits. These medications famously interfere with the production
of Coenzyme Q 10, which is needed for your body's energy production. So now
you have low thyroid hormone activity and are also on a medication that
interferes with energy production. It's no surprise if you cannot get yourself off the
floor.
Below are the common symptoms of low thyroid hormone. If you have these
symptoms, do not let your doctor tell you that your thyroid is OK unless he has
tested thoroughly and is aware of the facts I have just outlined for you.
Significant fatigue, lethargy, sluggishness, or history of low
thyroid at an earlier age
Hoarseness for no particular reason
Chronic recurrent infection(s)
16
Decreased sweating even with significant exercise
Depression, to the point of being a bothersome problem
A tendency to be slow to heat up, even in a sauna
Constipation despite adequate fiber and liquids in diet
Brittle nails that crack or peel easily
High cholesterol despite good diet
Frequent headaches (especially migraine)
Irregular menses, PMS, ovarian cysts, endometriosis
Unusually low sex drive
Red face with exercise
Accelerated worsening of eyesight or hearing
Palpitations or uncomfortably noticeable heartbeat
Difficulty in drawing in a full breath for no apparent reason
Mood swings, especially anxiety, panic or phobia
Gum problems
Mild choking sensation or difficulty swallowing
17
Excessive symptoms of menopause, not well relieved with
estrogen
Major weight gain
Aches and pains in limbs unrelated to exertion
Skin problems like adult acne, eczema, or severe dry skin
Vague and mildly annoying chest discomfort, unrelated to
exercise
Feeling off balance
Infertility
Annoying burning or tingling sensations that come and go
The experience of being colder than other people around you
Difficulty maintaining standard weight with a sensible food intake
Problems with memory, focus or concentration
Excessive amounts of hair that come out in you brush or in the
shower drain
Difficulty maintaining stamina throughout the day
18
The physical signs of low thyroid hormone function include:
low basal temperature in early morning (average of less than
98.0 degrees over 7 days)
slow movements, slow speech, slow reaction time
muscle weakness
thick tongue (tongue seemingly too big for mouth)
swelling of feet
swelling of eyelids or bags under eyes
decreased color of lips or yellowing of skin
swelling at base of neck (enlarged thyroid gland)
asymmetry, lumpiness, or other irregularity of thyroid gland
swelling of face
excess ear wax
dry mouth and/or dry eyes
noticeably cool skin
excessively dry or excessively coarse skin
especially low blood pressure
19
decreased ankle reflexes or normal reflexes with slow recovery
phase
noticeably slow pulse rate without having exercised regularly
loss of outer one-third of eyebrows
You can have these symptoms and see these physical signs with conditions
other than thyroid disorder. Also, you can have syndromes that may exist
concurrent with thyroid disorder. So you really need a thoughtful, concerned, well
informed clinician to look at this with you.
The connections between hypothyroidism, autism and other psychiatric/neurologic disorders
Balanced thyroid hormone is intimately connected with brain development during
the period beginning when you are still unborn and extending through the first
two to three years of your life. Thyroid hormone regulates the number of brain
cells you develop, their migration to the right site in your brain, and their
differentiation into the kind of cell appropriate for that region. Thyroid hormone
also regulates development of cells that make neurotransmitters, important
communication molecules in the brain.
Evidence supports a link between hypothyroidism and autism. One of the most
effective therapies for autism spectrum disorders and pervasive developmental
20
delay is a gluten-free diet. Recent studies indicate that gluten free diets can also
resolve the antibodies that form against the thyroid in autoimmune thyroid
disorder.
Mitochondria are the energy producing units in your cells. Mitochondrial function
and the ability to form and absorb appropriate forms of folic acid are regulated by
thyroid hormone. Mitochondrial disorder and autism frequently occur together.
The role of thyroid hormone in psychiatric disorder is also pivotal. Besides the
obvious correlation between the symptoms of low thyroid and psychiatric
symptoms, there are other ways in which disturbed thyroid hormone function can
produce psychiatric or neurologic disorder.
Hypothyroidism, cholesterol lowering medications, and dementia
Estrogen is especially important to your brain. It maintains the integrity of your
brain's tissue. You lose function in key neural structures when estrogen levels
drop. Either too much or too little estrogen can cause depression, which is
related to why women are twice as likely as men to get depressed.
Estrogen is known to have a protective effect on the motor system involved in
Parkinson’s disease. Low estrogen may lead to muscle twitches and restless
legs, among worse symptoms and disorders.
21
Estrogen also selectively enhances the main site of memory in your brain. Earlier
I discussed the medications used for high cholesterol, some of which are called
'the statin drugs'. These drugs interfere with estrogen production by inhibiting the
enzyme HMG-CoA-reductase. This enzyme is necessary for cholesterol
production in the brain. Patients taking HMG-CoA-reductase inhibitors get
dementia at an earlier age than those not using these medications.
Hormones and neurotransmitters
Cholesterol is the precursor needed to make estrogen, progesterone and
testosterone, your sex hormones. Sex hormones are essential to proper
neurologic and psychiatric function. Hormones impact your mood and brain via
important communication networks in your body. Every biologic function, every
brain function, every cell function, is under nervous system control by way of
small protein molecules called neurotransmitters (NTs). NTs are the messenger
molecules in your nervous system's network that coordinate all of the various
functions in your body.
NTs function like a key. The receptor for the neurotransmitter (NT) embedded in
your cell wall is like the lock. When the NT fits into the receptor, it induces your
cell to perform the function involved with the particular NT/receptor system.
22
NT receptor sites are present in every organ and system, just as estrogen
receptors are. There are receptor sites for NTs located in your gastrointestinal
tract, on your heart and circulatory system, your endocrine organs, and your
immune system. Receptor sites for NTs are everywhere.
Your most important relaxing NT is serotonin. It is your ‘feel good’ NT. It
modulates mood and pain pathways. When serotonin drops, it causes
depression, anxiety, sleep disturbance, memory loss, impaired concentration and
increased pain sensitivity.
Estrogen supports serotonin. They strengthen one another. So when menopause
causes your estrogen levels to drop, your brain function actually declines, and
your emotions may become erratic as well.
Serotonin impacts your thyroid gland also. Estrogen and serotonin both enhance
thyroid hormone production. There are receptor sites for serotonin in your brain
that have a direct effect on how much thyroid stimulating hormone (TSH) your
anterior pituitary can produce when it gets a low thyroid hormone signal. When
your body needs thyroid hormone, you would expect your TSH level to be
elevated. Elevated TSH is still the only test for low thyroid function that most
doctors acknowledge.
23
If you do not have enough serotonin, the ability of your brain to make TSH
is blunted. This is scientific fact. There is no dispute about this. With too little
serotonin, you may have low thyroid hormone, but your brain cannot make TSH.
So your TSH level will be low. And because your TSH is low, your doctor will
assume that your thyroid is fine.
Thus, the one test that your doctor relies on to detect thyroid disorder may actually reflect only low serotonin.
Beyond that, when thyroid function is diminished, your adrenal gland function is
reduced as well. So now you are low estrogen, low serotonin, low thyroid, and
low adrenal. In all, you feel terrible. And your doctor does not have a clue.
Convinced?
The thyroid/adrenal/estrogen/serotonin connection is only one of many important
molecular biologic connections in your body. Every day scientists learn more
about these important interconnections. It can take absurd lengths of time for this
information to filter down to the doctor treating you.
YOU are the one responsible for your own health. Do not delude yourself about
which direction healthcare is taking. Medical care cost cutting has just begun. Not
24
only are doctors using only one inappropriate test to uncover dysfunction in the
most central metabolic gland in your body, but in time they may need permission
to do even this one test.
If you think you may have undiagnosed thyroid disorder, or inadequately treated
thyroid disorder, stay in touch. I will be putting out educational materials that will
speak about the symptoms that you personally may be dealing with
give you an idea of what may be causing them
address the interventions that you may have already tried
give you information about why they did not work, and
discuss what you need to do next to make progress.
Together we can put you on the path to your thyroid solution!
25
Biography
Dr. Mullan is well known for being able to solve difficult health problems. She
works with people who are struggling with thyroid and other significant illness,
who are willing to use diet and genetics based nutritional supplementation, and
who want to increase well being and energy, enhance immunity, lift mood, fine
tune genetic function, and get their lives back.
Dr. Mullan has a passion for precision and getting it
right. She states, “People who are sick with thyroid
problems can be desperate for symptom resolution.
Their lives can be devastated by fatigue and other
impairments. I want to offer them something better than
mainstream misdiagnosis.” And she does this. Dr.
Mullan negotiates the labyrinth of thyroid illness to
finally get symptom resolution.
Dr. Mullan has studied at a number of exceptional institutions: the University of
Pennsylvania, Tufts University School of Medicine, and the University of Chicago
Hospitals and Clinics. She excels at integrating the results of biochemical and
genetic testing into sustained clinical improvement for you. She has succeeded
26
with patients who confounded the specialists at Massachusetts General Hospital,
the Mayo Clinic, the Cleveland Clinic, Stanford, and many well-known integrative
medical doctors. When recommending her, her patients say, “This is the woman
you need to talk to. She really knows how to handle tough clinical problems.”
Dr. Mullan’s specialty areas are MTHFR+, Methylation Genetics, and genetics
based nutritional supplementation. Within this context, she most often works with
Thyroid Disorder, Chronic Fatigue Syndrome, Lyme Disease, Psychiatric
Disorders, Autism Spectrum Disorders, Women’s Health Issues, Gastrointestinal
Disorder, and Heavy Metal Toxicity. She can teach you what you need to know
about how to get well!
6Ed